围术期使用帕瑞昔布钠对腰椎内固定手术镇痛效果影响的前瞻性随机对照研究

目的探讨围术期使用帕瑞昔布钠对腰椎内固定手术镇痛效果的影响。方法 2011年6月～2012年1月择期在全身麻醉下行腰椎内固定手术40例,按随机数字表分为对照组和帕瑞昔布钠组,每组各20例。诱导前帕瑞昔布钠组给予帕瑞昔布钠40 mg,对照组给予生理盐水2 ml。术毕连接电子镇痛泵,镇痛药物配方为舒芬太尼200μg＋欧贝8 mg＋0.9%NaCl稀释至200 ml,无背景剂量,病人自控静脉镇痛（patient-controlled intravenous analgesia,PCIA）单次注射剂量2 ml,锁定时间20 min。帕瑞昔布钠组术后12、24、36、48、60 h分别给予帕瑞昔布钠40 mg,对照组给予生理盐水2 ml。分别记录术后2、24、48、72 h的疼痛评分,24、48、72 h的舒芬太尼用量、睡眠质量评分,使用镇痛泵期间的恶心评分和术后72 h切口总引流量。结果术后2 h,帕瑞昔布钠组和对照组视觉模拟评分（visual analogue score,VAS）分别为（2.20±0.61）分和（3.21±0.71）分,帕瑞昔布钠组明显低于对照组（t=-4.825,P=0.000）;术后48 h,帕瑞昔布钠组和对照组VAS评分分别为（2.05±0.76）分和（2.85±0.75）分,帕瑞昔布钠组明显低于对照组（t=-3.351,P=0.002）;其余各时点2组VAS评分均无统计学差异（P〉0.05）。2组术后24、48 h舒芬太尼用量无显著性差异（54.8±18.2）μg vs.（53.2±14.2）μg,t=0.310,P=0.758;（97.4±30.3）μg vs.（108.6±19.8）μg,,t=-1.384,P=0.174];术后72 h,对照组舒芬太尼用量显著高于帕瑞昔布钠组〔（166.2±18.7）μg vs.（139.8±37.6）μg,t=2.810,P=0.008〕;手术日帕瑞昔布钠组睡眠质量评分明显低于对照组（Z=-2.572,P=0.010）;2组恶心评分和切口引流量差异无显著性（P〉0.05）。结论围术期使用帕瑞昔布钠可以改善腰椎内固定手术的镇痛效果,减少舒芬太尼用量。

Perioperative Analgesic Effects of Parecoxib on Patients Undergoing Internal Fixation of the Lumbar Spine: Randomized Controlled Trial

Objective To evaluate the analgesic efficacy of parecoxib during and after internal fixation of the lumbar spine. Methods Since June 2011 to January 2012, 40 patients undergoing elective internal fixation of the lumbar spine were randomly assigned to receive parecoxib （group P） or saline （group N, 20 patients in each）. Before induction, parecoxib 40 mg or saline 2 ml was administered in the groups P and N respectively. After the operation, patient-controlled intravenous analgesia （PCIA） pumps （ sufentanil 200 μg ＋ ondansetron hydrochloride 8 mg ＋ 0.9% NaC1 200 ml） were employed in both the groups. The bolus injection dose of the pump （PCIA） was set at 2 ml, without continuous infusion, while the lockout time was set at 20 rain. Parecoxib 40 mg or saline 2 ml was given at 12, 24, 36, 48, and 60 hours in the groups. At 2, 24, 48 and 72 hours, the visual analogue score （VAS） was measured respectively. At 24, 48 and 72 hours, the daily sufentanil consumption and sleeping score were recorded. The amount of postoperative drainage and nausea score were recorded. Results The VAS in the group P at 2 and 48 hours （2.20 ± 0.61 and 2.05 ±0.76） were significantly lower than those in group N （3.21±0.71 and 2.85 ±0.75; t = -4. 825, P =0. 000, and t = -3. 351, P =0. 002, respectively） , while no significantly differences were detected at the other time points between the two groups. No significant differences were detected in the daily sufentanil consumption at 24 and 48 hours （54.8 ± 18.2）μg vs. （53.2 ±14.2） μg, t=0.310, P=0.758; （97.4±30.3） μg vs. （108.6 ±19.8） μg, t = -1.384, P=0. 174]. The amount of sufentanil consumption was significantly larger in the group N than group P at 72 hours （166.2± 18.7） mg vs. （139.8 ± 37.6） mg, t = -2. 810, P =0.008]. The sleeping score in the group P was significantly lower than that in the group N on the operation day （Z =-2. 572, P =0. 010）. There were no significant differences in nausea score and the amount of postoperative drainage between the groups（P 〉 0.05 ）. Conclusion Perioperative administration of parecoxib can improve analgesic effects after internal fixation of the lumbar spine, and reduce the requirement of sufentanil.